779 doi: 10.5606/tgkdc.dergisi.2015.11406
Turk Gogus Kalp Dama 2015;23(4):779-780
Interesting Image / İlginç Görüntü
Surgery for severe aortic coarctation in a 55-year-old female patient
Elli beş yaşında kadın hastada ciddi aort koarktasyonu cerrahisi
Mehmet Taşar, Evren Özçınar, Bledar Hodo, Alper Özgür, Sadık Eryılmaz, Bülent Kaya
Aortic coarctation is a segmental narrowing of the descending aorta which commonly located distally to the origin of the left subclavian artery.[1] This congenital anomaly is frequently diagnosed and treated in childhood; however, it can be left undiagnosed until adulthood.[2] In this article, we present a 55-year-old female case with severe aortic coarctation with 30 mmHg gradient, distal to the origin of the subclavian artery with post-stenotic dilatation (Figure 1). Computed tomography angiography
revealed calcification and aortic wall irregularities of pre-coarctation segment (Figure 2a) despite no changes in post-coarctation segment (Figure 2b). She was on anti-hypertensive therapy for almost 20 years. Transthoracic echocardiography revealed severe aortic valve stenosis with a mean gradient of 52 mmHg and 42 mm ascending aorta. The patient underwent graft bypass surgery with left posterolateral thoracotomy. A 16 polytetrafluoroethylene tubular graft was anastomosed distally to the origin of the
Received: December 31, 2014 Accepted: April 08, 2015
Correspondence: Mehmet Taşar, M.D. Ankara Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, 06100 Cebeci, Ankara, Turkey.
Tel: +90 312 - 595 60 00 e-mail: [email protected] Available online at
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Department of Cardiovascular Surgery, Medical Faculty of Ankara University, Ankara, Turkey
Figure 1. Computed tomography angiography
showing severe aortic coarctation and post-stenotic dilatation.
Figure 2. Computed tomography angiography of
precoarctation and post-coarctation segment (2a: Arrow shows calcification and wall irregularities of pre-coarctation segment, 2b: There is no changes on aortic wall of post-coarctation segment).
(a)
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left subclavian artery using side biting clamp and distal part of the graft was anastomosed beneath the aneurysmatic segment of the descending aorta. Postoperative period was uneventful. Beta-blocker monotherapy was used to control the blood pressure. Surgery was planned for aortic valve disease. Aortic coarctation is rarely seen in adult patients. Graft bypass is a safe and effective treatment.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research and/or authorship of this article.
REFERENCES
1. Leetmaa TH, Nørgaard BL, Mølgaard H, Jensen JM. Severe aortic coarctation in an adult patient with normal brachial blood pressure. J Clin Imaging Sci 2014;4:41.
